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UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Page 6 of 6 X11. LINE LEAK DETECTOR TESTING ❑ Check this box If line leak detectors (LLD) are NOT installed. (Do not complete this section.) Y N NA This section must be com feted NLLDs are Installed. Was a leak simulated to verify LLD performance? ® ❑ ❑ Check all that a Simulated leak rate verified: ® 3 GPH ❑ 0. 1 GPH ❑ 0.2 GPH Was the testing apparatus properly calibrated? T0 ,03 ❑ For emergency generator tank systems, does the LLD create an audible and visual alarm when a leak is detected? For mechanical LLDs, does the LLD restrict the flow through the pipe when a leak is detected?For electronic LLDs, does the turbine automatically shut off when a leak is detected? ElFor electronic LLDs, does the turbine automatically shut off If any portion of the monitoring system is disabled or disconnected? ❑ For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or falls a test? 10 ❑ ❑ For electronic LLDs, have all accessible wiring connections been visually inspected for kinks and breaks? ® ❑ ❑ Were all items on the equipment manufacturer's maintenance checklist completed? ® ❑ ❑ Were all LLDs confirmed operational within regulatory requirements? ® ❑ ❑ For any answer of "N" above describe in section XI11 how and when these Issues were or will be corrected. XIII. COMMENTS AAR i F7 iql XIV. VACUUM / PRESSURE/ HYDROSTATIC MONITORING EQUIPMENT TESTING ❑ Check this box if VPH monitoring is NOT used . (Do not complete this section) This section must be completed if VPH monitoring is used to perform leak defection monitoring. System Type (Mark all that apply.) ® Vacuum ❑ Pressure ❑ Hydrostatic Sensor Functionality Interstitial Communication Sensor ID Component(s) Monitored by this Sensor Test Test S9 87 VACUUM PRODUCT ® Pass ❑ Fail ® Pass El Fall S10 87 VAPOR VENT VACUUM ® Pass ❑ Fait ® Pass ❑ Fail S11 91 VACUUM PRODUCT ® Pass El Fail ® Pass ❑ Fail S12 91 VENT VACUUM ® Pass ❑ Fait ® Pass ❑ Faii ❑ Pass © Fall ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Faii ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fall ❑ Pass ❑ Fail How was interstitial communication verified? ® Simulated leak at far ends of the Interstitial space. ❑ Visual Inspection ❑ Other (Describe the method In section XV below.) [I Gauge Was the vacuum or pressure restored to operating levels in all interstitial spaces? ® Yes ❑ No (Describe the reason in section XV below.) For an answer of "FAIL" above describe in section XV how and when !hese issues were or will be corrected. XV. COMMENTS f,PN a rar4v�c nW' t1fN u' Y = Yac N = Nn NO = N� anr9tral�IP VPH = Van n nnrPnscc� uoh�vrt � Ill = ttiarMifit�tinn